结构评估和决策工具（I-DECIDED®）对改善外周静脉导管护理的影响：一项多中心、中断时间序列研究。

The impact of a structured assessment and decision tool (I-DECIDED®) on improving care of peripheral intravenous catheters: A multicenter, interrupted time-series study.

机构信息

School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.

Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; The Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, United States of America; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.

出版信息

Int J Nurs Stud. 2023 Dec;148:104604. doi: 10.1016/j.ijnurstu.2023.104604. Epub 2023 Sep 9.

DOI:10.1016/j.ijnurstu.2023.104604

PMID:37801935

Abstract

BACKGROUND

Peripheral intravenous catheters are the most widely used invasive device in hospitals but have serious risks.

OBJECTIVE

To determine if a structured assessment and decision tool (I-DECIDED®) improves daily peripheral intravenous catheter assessment and care decisions.

DESIGN

Prospective, interrupted time-series study.

SETTINGS

Seven adult inpatient wards in three Australian hospitals.

PARTICIPANTS

825 adults with 867 peripheral intravenous catheters.

METHODS

Between August 2017 and December 2018, peripheral intravenous catheter assessments and chart audits were undertaken with informed patient consent. Following a 4-month pre-intervention period (with 2-weekly measures), the I-DECIDED® tool was implemented over 3 months (no data collection) using multiple strategies (stakeholder meetings, vascular access device form, education sessions, ward champions, lanyard cards, and posters), followed by a 4-month post-intervention period (with 2-weekly measures). Primary outcomes were device utilization (number of peripheral intravenous catheters per total number of patients screened); idle/unused catheters; insertion site complications, substandard dressing quality; and primary bloodstream infections.

RESULTS

Of 2055 patients screened, 1175 (57.2%) had a peripheral intravenous catheter, and 825 patients (867 catheters) consented and were included in the final analysis. Device utilization increased from 42.0% of catheters at baseline to 49.6% post-intervention (absolute risk difference [ARD] 7.5%, 95% confidence interval [CI] 4.8, 10.3; relative risk [RR] 1.18, 95% CI 1.11, 1.25; p < 0.001). The proportion of idle catheters reduced from 12.7% to 8.3% (ARD -4.4%, 95% CI -8.5, -0.3; RR 0.66, 95% CI 0.44, 0.97; p = 0.035). Peripheral intravenous catheter complications reduced from 16.1% to 10.9% (ARD -5.2%, 95% CI -9.7, -0.6; RR 0.68, 95% CI 0.48, 0.96; p = 0.026). Substandard dressings reduced from 24.6% to 19.5% (ARD -5.2%, 95% CI -10.7, 0.4; RR 0.79, 95% CI 0.61, 1.02; p = 0.067). Only one primary bloodstream infection occurred (post-intervention).

CONCLUSIONS

Implementation of a comprehensive device assessment and decision tool (I-DECIDED®) reduced idle catheters and catheter complications, despite higher device utilization. Dressing quality improved but was not statistically significant. Further implementation of the tool could improve hospital safety for patients with an intravenous catheter.

ANZCTR TRIAL REGISTRATION

ACTRN12617000067370. Date of registration 13 January 2017. Date of first data collection 3rd August 2017.

TWEETABLE ABSTRACT

#IDECIDEDassessment reduces prevalence of idle peripheral catheters and device complications.

摘要

背景

外周静脉导管是医院中使用最广泛的侵入性装置，但存在严重的风险。

目的

确定结构化评估和决策工具（I-DECIDED®）是否能改善外周静脉导管的日常评估和护理决策。

设计

前瞻性、中断时间序列研究。

设置

澳大利亚三家医院的七间成人住院病房。

参与者

825 名成人，867 个外周静脉导管。

方法

在 2017 年 8 月至 2018 年 12 月期间，在获得患者知情同意的情况下进行外周静脉导管评估和图表审核。在 4 个月的干预前阶段（每两周进行一次评估）后，使用多种策略（利益相关者会议、血管通路装置表格、教育课程、病房负责人、挂牌和海报）实施 I-DECIDED®工具 3 个月（不进行数据收集），随后进行 4 个月的干预后阶段（每两周进行一次评估）。主要结果是设备利用率（接受筛查的患者总数中使用的外周静脉导管数量）；闲置/未使用的导管；插入部位并发症、不合标准的敷料质量；以及原发性血流感染。

结果

在接受筛查的 2055 名患者中，有 1175 名（57.2%）患者有外周静脉导管，825 名患者（867 个导管）同意并纳入最终分析。设备利用率从基线时的 42.0%上升到干预后的 49.6%（绝对风险差异 [ARD] 7.5%，95%置信区间 [CI] 4.8，10.3；相对风险 [RR] 1.18，95% CI 1.11，1.25；p<0.001）。闲置导管的比例从 12.7%降至 8.3%（ARD-4.4%，95%CI-8.5，-0.3；RR 0.66，95%CI 0.44，0.97；p=0.035）。外周静脉导管并发症从 16.1%降至 10.9%（ARD-5.2%，95%CI-9.7，-0.6；RR 0.68，95%CI 0.48，0.96；p=0.026）。不合标准的敷料从 24.6%降至 19.5%（ARD-5.2%，95%CI-10.7，0.4；RR 0.79，95%CI 0.61，1.02；p=0.067）。仅发生了 1 例原发性血流感染（干预后）。